W5: Headaches Flashcards
How many types of primary headaches are there? Name them.
Migrane (Vascular origin)
Cluster (Vascular origin)
Tension-type (Muscular origin)
Other
Prevalence and definition of a secondary headache
18%
Headache in close temporal relation to another disorder (ie another condition causes pain in the head or neck)
Name types of secondary headaches
Trauma related headache eg whiplash/concussion
Cervicogenic headache (related to neck pain)
Medication overuse headache
Headache related to an intercranial neoplasma, HTN or fasting
Trigeminal neuralgia (nerve pain that affects the face)
Other: Caffeine withdrawal or exercise/exertion headache
How many different headache disorders are there?
Lifetime prevalence?
…. leading causing of years lived with disability world-wide?
200 +
65-90%
2nd
What is a migraine?
Chronic neurological disorder characterized by moderate or severe headache (Note: the neurological and systemic symptoms are reversible).
Key symptoms of migraine?
Photophobia (eyes are sensitive to light)
Phonophobia (fear of loud sounds - can commonly trigger symptoms)
Nausea
Vertigo
Dizziness
Tinnitus
Migraine percentages:
- Unilateral
- Aggravated by PA
- Accompanying neck pain
60% unilateral
90% aggravated by PA
75% accompanied by neck pain
Migraine:
1 year prevalence
Female vs male
12% 1 year prevalence (high prev in Aus & East Europe)
Female 18%
Male 6%
Define a tension headache
Featureless headache that is characterized by nothing more than a pain in the head, assuming that some kind of mental or muscular tension might have a causative role
Tension headache
Cause?
Unilateral/bilateral?
Lifetime prevalence?
Unknown
Bilateral
79%
Cause is uncertain
Tightened muscles, Temporomandibular disorders, sleep problems or Stress?
What is a cervicogenic headache?
Headache results from cervical spine (referred pain)
Characteristics of cervicogenic headache?
- Headache associated with cervical stiffness
- Mostly unilateral
Cervicogenic headache: males vs females?
Female / male : 4 / 1
C0-C3 rotation and flexion/extension % of movement?
- 60% of all rotation
- 33% of all flexion/extension
Where is the prevalence of tension-type headaches high?
South America (moderate in Aus)
Redflags to observe in headache patients? DIAGRAM
- Rapid onset of symptoms (consider TIA, sinus venous, thrombosis)
- Thunderclap headache
- Presence of neurologic symptoms and signs
- Prominent neck pain with or without fever (consider meningitis, lumbar puncture, etc)
- Age at onset >50 (giant cell arthritis, intracranial tumour, HTN)
- Worsening with positional changes or valsalva maneuver
- New or worsening headache in patient with history of migraine
Headache red flags (MC Notes). 6 Ps + MORE
- 65 years
- Pattern change
- Sudden onset
- Papilledema (swelling of optic discs in the eye)
- HA due to coughing, sneezing, exercise
- Positional HA
- Pathology of immune system (HIV)
- Atypical presentation
- History of malignancies
- Systemic symptoms + fever
- Pregnancy
- Neurological deficit (consciousness)
- Painful eye
- Posttraumatic onset
Prognostic/diagnostic factors for migraine
Unilateral
Nausea/vomitting
Aggravated by PA
Prognostic/diagnostic factors for cervicogenic headache
Unilateral
Aggravation by head movements
Prognostic/diagnostic factors for medication overuse?
Family history
Prognostic/diagnostic factors for tension-type headache?
Bilateral
No Nausea
No aggravation
Physical examine for a headache?
- Postural assessment
- Active Range of Motion (1st image)
- Neck Flexion strength test (below image)
- Craniocervical flexion test (CCT) - uses the biofeedback cuff to assess deep neck flexors
- Passive accessory intervertebral movements (PAIVM) for C0-C3
- (Cervical) Flexion Rotation Test (CFRT)
- Check temporomandibular joints
Note: the cervical flexion rotation test is when the examiner passively positions the patient’s neck into full flexion to pre-tension the structures of the middle and lower cervical spine, then the patient’s head is passively rotated each direction while the flexed position is maintained.
Two key exams to assess in a cervicogenic headache?
Active ROM (generally reduced)
Flex Rot Test
For a migraine does acupuncture have effectiveness?
YES
Cochrane review found it was moderately beneficial